Philippe Charlier and colleagues describe how the Romans wiped their bottoms and speculate about the resulting health problems

The first mention of toilet paper in the Western world comes from the 16th century, with a short description by the French novelist (and physician) François Rabelais arguing its ineffectiveness.1 China, however, had toilet paper in the 2nd century BC,2 and the Japanese used chuugi (20-25 cm wooden sticks) during the Nara period (8th century AD) for both external and internal cleaning of the anal canal. Other cultures do not use toilet paper, partly because paper is often not easily available. Anal cleaning can be carried out in various ways according to local customs and climate, including with water (using a bidet, for example), leaves, grass, stones, corn cobs, animal furs, sticks, snow, seashells, and, lastly, hands.

During the Greco-Roman period, a sponge fixed to a stick (tersorium) was used to clean the buttocks after defecation; the sponge was then replaced in a bucket filled with salt water or vinegar water.3 Another technique was to use oval or …

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